Personality Disorders in Forensic Populations: Epidemiological, Clinical, and Diagnostic Characteristics

Personality disorders are markedly overrepresented among justice-involved populations and represent a major challenge in forensic psychiatry. This narrative review aims to describe the epidemiological, clinical, and diagnostic characteristics of personality disorders in offenders, as well as their comorbidity with substance use disorders, based on a synthesis of the recent literature. Available evidence consistently demonstrates a particularly high prevalence of personality disorders in correctional and forensic settings, predominantly antisocial personality disorder and psychopathy, while also highlighting borderline personality disorder, which is more common among incarcerated women, narcissistic personality disorder, and mixed personality presentations. These disorders are frequently associated with substance use disorders and other psychiatric comorbidities, thereby complicating diagnostic assessment and worsening clinical outcomes. The underlying neurobiological, cognitive, and developmental mechanisms vary across clinical profiles and may account for the heterogeneity of violent behaviors observed in forensic populations. From a diagnostic perspective, the transition toward dimensional models, particularly those adopted in the ICD-11 and the Alternative DSM-5 Model for Personality Disorders (AMPD), enables a more refined characterization of disorder severity and maladaptive personality trait domains. Finally, this review highlights several methodological limitations in the current literature, including diagnostic heterogeneity across studies, the predominance of male samples from high-income countries, and the scarcity of longitudinal research, underscoring the need for more standardized and cross-cultural investigations.